Repeat scripts rife


prescription

Providing repeat scripts of antibiotics may be leading to hoarding for future use, say pharmacy researchers

A retrospective study by researchers from the University of Tasmania and Curtin University has examined antibiotic repeat dispensing records from 186 Australian pharmacies.

After examining more than 12,000 repeat dispensings for amoxycillin and cephalexin, the researchers discovered that dispensing ranged from on or the day after the original, to 12 months later.

About 50% of amoxycillin and 80% of cephalexin were collected within two and 30 days of the date on which the original supply should have been completed.

Meanwhile, one in five (20%) occurred at least one month after the initial prescription, suggesting they were used to treat a separate episode of infection.

The remainder were dispensed throughout the following 11 months.

And while prescriptions which specified a course length exceeding the original pack were associated with a significantly shorter interval between dispensing of original and repeat prescriptions, the vast majority of prescriptions were only annotated with generic course completion advice.

“Our data suggest that in many cases, the use of repeat prescriptions leads to antibiotic treatment durations considerably longer than necessary, which may tip the balance of benefit and risk toward adverse consequences for the patient, and add to selective antimicrobial pressures,” say the researchers.

“Of further concern is the finding that 21.2% of prescriptions were dispensed 30 days or more after the expected completion date of the initial pack.”

“The use of a repeat supply at least one month after the original antibiotic prescription was written is most likely to reflect use for a separate episode of suspected infection.”

That prescriptions continued to be dispensed through to the last week of their 12-month validity suggests some patients may choose to have repeats dispensed to keep on standby for future use, they say.

Course lengths that were stated on the prescriptions, especially where they are extended, is associated with “a more desirable pattern of patient behaviour”, say the authors.

“If adding such directions can change patient behaviour when using antibiotics, there is a significant opportunity to increase the prevalence of such advice and improve practice.

“Medical and pharmacy professionals must reflect on their current practices in regard to if, and how, they issue antibiotic prescriptions and what advice on course lengths is provided.”

Journal of Pharmacy Practice and Research 2017; online 11 September

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